Abstract:

BACKGROUND: The treatment of displaced acetabular fractures consists of formal open reduction and internal fixation. However, extensile exposure can lead to a lot of complications. Percutaneous screw fixation for acetabukar fractures can decrease these complications. Recently developed fluoroscopic-based computerized navigation technology not only allows the surgeon to achieve maximum accuracy of screw fixation but also significantly reduce radiation exposure time.
OBJECTIVE: To evaluate the clinical application of the fluoroscopic-based computerized navigation system for percutaneous screwing for acetabular fractures.
METHODS: A total of 18 adult patients with 20 non-displaced and displaced acetabular fractures were treated with percutaneous screw fixation under the guidance of a fluoroscopy-based navigation system. All acetabular fractures were acetabular anterior column fractures and posterior column fractures, which were fixed by varied hollow screws. Static muscle contraction and limited active and passive motion were performed at 2 days, and weight-bearing exercise was performed at 4 weeks after operation. The time of screw implantation, screw position deviation, screw biocompatibility, as well as adverse effect after screw implantation was observed. In addition, d'Aubigne and Postel scoring was used in follow-up.
RESULTS AND CONCLUSION: A total of 30 acetabular screws were inserted. The average operation time for per screw was 24.1 minutes from the image acquisition to wound closure. The average fluoroscopic time for per screw was 27.6 seconds. Compared to the final position of the screw, the average wire tip error was 1.5 mm and the average trajectory difference was 2.25°. One patient sustained a transient femoral nerve palsy which was attribute to reduction clamp inserting from the use of the limited open reduction method rather than screw fixation itself and resolved 2 months after the operation. No evidence was noted of secondary displacement of the fragment or screw failure. Using the rating system of d’ Aubigne and Postel, 13 patients had excellent results, 4 patients had good results, and 1 patient had a fair result. The excellent to good rate was 94%. All results demonstrated that percutaneous screw fixation of acetabular fractures with fluoroscopy-based navigation can produce excellent results in selected patients with non-displaced and displaced fracture amenable to closed or limited open reduction, which becomes a safe and effective alternative to traditional open reduction and internal fixation for the treatment of certain acetabular fractures.